Urinary transglutaminase 2 as a potent biomarker to predict interstitial fibrosis and tubular atrophy of kidney allograft during early posttransplant period in deceased donor kidney transplantation

PURPOSE: Transglutaminase type 2 (TG2) is an extracellular matrix crosslinking enzyme with a pivotal role in kidney fibrosis. We tested whether quantification of urinary TG2 may represent a noninvasive method to estimate the severity of kidney allograft fibrosis. METHODS: We prospectively collected urine specimens from 18 deceased donor kidney transplant recipients at 1-day, 7-day, 1-month, 3-month, and 6-month posttransplant. In addition, kidney allograft tissue specimens at 0-day and 6-month posttransplant were sampled to analyze the correlation of urinary TG2 and kidney allograft fibrosis. RESULTS: Thirteen recipients had increased interstitial fibrosis and tubular atrophy (IFTA) scores at the 6-month protocol biopsy (IFTA group). The mean level of urinary TG2 in the IFTA group was higher compared to that of 5 other recipients without IFTA (no IFTA group). Conversely, the mean level of urinary syndecan-4 in the IFTA group was lower than levels in patients without IFTA. In the IFTA group, double immunofluorescent staining revealed that TG2 intensity was significantly upregulated and colocalizations of TG2/heparin sulfate proteoglycan and nuclear syndecan-4 were prominent, usually around tubular structures. CONCLUSION: Urinary TG2 in early posttransplant periods is a potent biomarker for kidney allograft inflammation or fibrosis.

Kidney Transplantation from the Deceased Donor Who Need Continuous Renal Replace Therapy / 대한이식학회지

BACKGROUND: Brain death donors may require continuous renal replacement therapy (CRRT) in severe acute renal failure (ARF) during management. To maximize donor organ usage we performed renal transplantation from deceased donors requiring CTTR with informed consent. This single-center study reviewed the clinical outcomes of kidney transplant recipients from extreme marginal donors requiring CRRT. METHODS: Medical records of all patients using a graft from extreme marginal donors who underwent CRRT in Asan Medical Center between June 2007 and September 2014 were reviewed retrospectively. RESULTS: Between June 2007 and September 2014, 27 kidneys were transplanted from 19 CRRT donors. Mean donor age was 35.1 years (range; 16~56), male donors were 14 (74%). The causes of brain death included head trauma in 6, hypoxia in 5, stroke in 4, and others in 4. The main causes of CRRT were anuria in 14, electrolyte imbalance or acidosis in 5, and mean duration of donor CRRT was 3.6 days (range; 1~11). Delayed graft function (DGF) developed in 24 (88.9%), but all recovered renal function; they can be free from dialysis 11 days after transplantation. Mean serum creatinine level at 1 month, 1 year, and 5 years was 1.85, 1.26, and 1.31 mg/dL, respectively. CONCLUSIONS: Five-year follow-up data showed that renal transplantation from severe ARF donor has an excellent outcome. Although CRRT donor kidney transplants have a higher rate of DGF, the presence of DGF, unlike other donation after brain death donor kidney transplants, does not portend a worse prognosis.